Bilateral Sixth Nerve Palsies as the Sole Manifestation of Atypical Miller-Fisher Syndrome

양측 외전신경마비만을 보인 비전형적 Miller-Fisher 증후군

  • Nho, Sang-Woo (Department of Neurology, Inje University College of Medicine, Busan Paik Hospital) ;
  • Kim, Jong-Kuk (Department of Neurology, Dong-A University Postgraduate Medical School) ;
  • Park, Whan-Seok (Department of Neurology, Inje University College of Medicine, Busan Paik Hospital) ;
  • Jung, Eun-Joo (Department of Neurology, Inje University College of Medicine, Busan Paik Hospital) ;
  • Kim, Sang-Jin (Department of Neurology, Inje University College of Medicine, Busan Paik Hospital) ;
  • Kim, Eung-Gyu (Department of Neurology, Inje University College of Medicine, Busan Paik Hospital) ;
  • Bae, Jong-Seok (Department of Neurology, Inje University College of Medicine, Busan Paik Hospital)
  • 노상우 (인제대학교 의과대학 부산백병원 신경과학교실) ;
  • 김종국 (동아대학교 의과대학 신경과학교실) ;
  • 박환석 (인제대학교 의과대학 부산백병원 신경과학교실) ;
  • 정은주 (인제대학교 의과대학 부산백병원 신경과학교실) ;
  • 김상진 (인제대학교 의과대학 부산백병원 신경과학교실) ;
  • 김응규 (인제대학교 의과대학 부산백병원 신경과학교실) ;
  • 배종석 (인제대학교 의과대학 부산백병원 신경과학교실)
  • Received : 2010.08.26
  • Accepted : 2011.01.11
  • Published : 2011.06.30

Abstract

Recently, we encountered a man with isolated bilateral sixth nerve palsies and areflexia whose titer of anti-GQ1b IgG antibody was elevated. We propose that bilateral sixth nerve palsies can be the sole manifestation of "anti-GQ1b antibody syndromes" and that patients with isolated bilateral sixth nerve palsies should be administered an anti-GQ1b antibody test for the diagnosis of acute immune-related neuropathy.

Keywords

References

  1. Kocak Z, Celik Y, Uzal MC, Uygun K, Kaya M, Albayram S. Isolated bilateral sixth nerve palsy secondary to metastatic carcinoma: a case report with a review of the literature. Clin Neurol Neurosurg 2003;106:50-54.
  2. Leigh RJ, Zee DS. Diagnosis of peripheral ocular motor palsies and strabismus. In: Leigh RJ, Zee DS, eds. The neurology of eye movement. New York: Oxford University Press. 1999;321-404.
  3. Bayrak AO, Tilki HE, Kasm D. A case of bilateral simultaneous sixth cranial nerve palsies secondary to diabetes mellitus. J Neuroophthalmol 2006;26:177-179. https://doi.org/10.1097/01.wno.0000235563.50518.d5
  4. Lo YL. Clinical and immunological spectrum of the Miller Fisher syndrome. Muscle Nerve 2007;36:615-627. https://doi.org/10.1002/mus.20835
  5. Chan YC, Wilder-Smith E, Chee MW. Acute ophthalmoplegia with pupillary areflexia associated with anti-GQ1b antibody. J Clin Neurosci 2004;11:658-660. https://doi.org/10.1016/j.jocn.2003.10.020
  6. Kim JK, Kim MJ, Yoo BG, Kim KS, Seo JH. Three cases of anti-GQ1b antibody syndrome with internal ophthalmoplegia. J Korean Neurol Assoc 2007;25:115-118.
  7. Odaka M, Yuki N, Hirata K. Anti-GQ1b IgG antibody syndrome: clinical and immunological range. J Neurol Neurosurg Psychiatry 2001;70:50-55. https://doi.org/10.1136/jnnp.70.1.50
  8. Tatsumoto M, Odaka M, Hirata K, Yuki N. Isolated abducens nerve palsy as a regional variant of Guillain-Barre syndrome. J Neurol Sci 2006;243:35-38. https://doi.org/10.1016/j.jns.2005.11.026
  9. Yuki N, Odaka M, Hirata K. Acute ophthalmoparesis (without ataxia) associated with anti-GQ1b IgG antibody: clinical features. Ophthalmology 2001;108:196-200. https://doi.org/10.1016/S0161-6420(00)00420-6